Surgeon Volume is a Poor Proxy for Skill in Esophageal Cancer Surgery

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Abstract
Objective: To evaluate the impact of surgeon volume on the risk of technical surgical complications after esophageal cancer resection. Summary Background Data: Severe postoperative complications occur in about half of esophagectomized patients. Of these, technical complications might be particular targets for improvement. Population-based studies of the influence of surgeon volume on technical complications are sparse. Methods: A prospective, nationwide, population-based study was conducted in Sweden in 2001 through 2005. Details concerning patient and tumor characteristics, surgical procedures, and predefined complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register. The surgeon volume cut-offs of 6 operations per annum were predefined on the basis of previous research. Multivariable logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 615 patients undergoing esophageal resection for cancer, 154 (25.0%) patients sustained at least 1 technical surgical complication. No association was found between high-volume surgery and decreased risk of such complications. Compared with high-volume surgeons, medium-volume surgeons had an adjusted OR of 0.80 (95% CI: 0.45–1.42) and low-volume surgeons had an OR of 0.99 (95% CI: 0.49–1.98) for occurrence of any technical surgical complication. Differences were found between individual HVSs regarding crude risk of anastomotic leakage (P < 0.042) and secondary surgical complications (P < 0.001). Conclusions: Surgeon volume seems to be a poor proxy for skill in esophageal cancer surgery. Other factors might be of more importance, as indicated by variations in outcome between individual experienced surgeons.